Brinton Eliot A, Triscari Joseph, Brudi Philippe, Chen Erluo, Johnson-Levonas Amy O, Sisk Christine McCrary, Ruck Rae Ann, MacLean Alexandra A, Maccubbin Darbie, Mitchel Yale B
Division of Atherometabolic Research, Utah Foundation for Biomedical Research, 420 Chipeta Way, Room 1160, Salt Lake City, UT, 84108, USA.
Merck & Co., Inc., Kenilworth, NJ, USA.
Lipids Health Dis. 2016 Jul 12;15(1):116. doi: 10.1186/s12944-016-0282-8.
LDL-C, non-HDL-C and ApoB levels are inter-correlated and all predict risk of atherosclerotic cardiovascular disease (ASCVD) in patients with type 2 diabetes mellitus (T2DM) and/or high TG. These levels are lowered by extended-release niacin (ERN), and changes in the ratios of these levels may affect ASCVD risk. This analysis examined the effects of extended-release niacin/laropiprant (ERN/LRPT) on the relationships between apoB:LDL-C and apoB:non-HDL-C in patients with T2DM.
T2DM patients (n = 796) had LDL-C ≥1.55 and <2.97 mmol/L and TG <5.65 mmol/L following a 4-week, lipid-modifying run-in (~78 % taking statins). ApoB:LDL-C and apoB:non-HDL-C correlations were assessed after randomized (4:3), double-blind ERN/LRPT or placebo for 12 weeks. Pearson correlation coefficients between apoB:LDL-C and apoB:non-HDL-C were computed and simple linear regression models were fitted for apoB:LDL-C and apoB:non-HDL-C at baseline and Week 12, and the correlations between measured apoB and measured vs predicted values of LDL-C and non-HDL-C were studied.
LDL-C and especially non-HDL-C were well correlated with apoB at baseline, and treatment with ERN/LRPT increased these correlations, especially between LDL-C and apoB. Despite the tighter correlations, many patients who achieved non-HDL-C goal, and especially LDL-C goal, remained above apoB goal. There was a trend towards greater increases in these correlations in the higher TG subgroup, non-significant possibly due to the small number of subjects.
ERN/LRPT treatment increased association of apoB with LDL-C and non-HDL-C in patients with T2DM. Lowering LDL-C, non-HDL-C and apoB with niacin has the potential to reduce coronary risk in patients with T2DM.
低密度脂蛋白胆固醇（LDL-C）、非高密度脂蛋白胆固醇（non-HDL-C）和载脂蛋白B（ApoB）水平相互关联，均可预测2型糖尿病（T2DM）和/或高甘油三酯（TG）患者发生动脉粥样硬化性心血管疾病（ASCVD）的风险。缓释烟酸（ERN）可降低这些水平，且这些水平比值的变化可能影响ASCVD风险。本分析研究了缓释烟酸/拉罗匹仑（ERN/LRPT）对T2DM患者载脂蛋白B与低密度脂蛋白胆固醇比值（apoB:LDL-C）及载脂蛋白B与非高密度脂蛋白胆固醇比值（apoB:non-HDL-C）之间关系的影响。
T2DM患者（n = 796）在经过4周的调脂导入期后，低密度脂蛋白胆固醇≥1.55且<2.97 mmol/L，甘油三酯<5.65 mmol/L（约78%的患者服用他汀类药物）。在随机分组（4:3）、双盲接受ERN/LRPT或安慰剂治疗12周后，评估apoB:LDL-C和apoB:non-HDL-C的相关性。计算apoB:LDL-C与apoB:non-HDL-C之间的Pearson相关系数，并对基线和第12周时的apoB:LDL-C和apoB:non-HDL-C拟合简单线性回归模型，研究实测载脂蛋白B与实测及预测的低密度脂蛋白胆固醇和非高密度脂蛋白胆固醇值之间的相关性。
在基线时，低密度脂蛋白胆固醇尤其是非高密度脂蛋白胆固醇与载脂蛋白B相关性良好，ERN/LRPT治疗增强了这些相关性，尤其是低密度脂蛋白胆固醇与载脂蛋白B之间的相关性。尽管相关性更强，但许多达到非高密度脂蛋白胆固醇目标尤其是低密度脂蛋白胆固醇目标的患者，其载脂蛋白B水平仍高于目标值。在较高甘油三酯亚组中，这些相关性有增加趋势，但可能由于样本量少而无统计学意义。
ERN/LRPT治疗增强了T2DM患者载脂蛋白B与低密度脂蛋白胆固醇及非高密度脂蛋白胆固醇之间的关联。用烟酸降低低密度脂蛋白胆固醇、非高密度脂蛋白胆固醇和载脂蛋白B有可能降低T2DM患者的冠心病风险。
